CONSEQUENCES OF PHYSICAL RESTRAINTS

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DESCRIPTION (PROVIDED BY APPLICANT): In nursing home inspections conducted by state licensure and certification agencies, a physical restraint is defined as a device that is attached and cannot be easily removed by the resident which restricts freedom of movement and/or normal access to his/her body. In 1989, it was estimated that 44 percent of all residents in nursing homes were physically restrained. More recent research suggests that 13 percent of all residents in nursing homes are now being physically restrained. Because of the adverse consequences of restraint use, there is concern that physical restraints are still being overused. These adverse consequences include falls, nosocomial infections, pressure sores, agitation of residents, and cognitive decline. One area of research that remains to be investigated is the nexus between the use of physical restraints and mental health. Previous studies use limited statistical tests, such as correlations and t-tests, that could not account for potential biases, such as whether residents who become mentally disturbed are most likely to be restrained. We propose to use linear models of change that are less susceptible to this bias. These prior studies laid the groundwork of mental health decline and physical restraint use, but this issue remains to be investigated further. It is proposed to use the newly available Minimum Data Set (MDS), representing nursing home residents in Pennsylvania, to examine the association between use of physical restraints, cognitive decline, alterations in mood, behavior problems, and social engagement. Clearly, understanding whether restraints contribute to mental health problems is important in a mental health and quality-of-care context. If restraints contribute to a decline in mental health, a more powerful rationale for their careful use may develop, helping reduce restraint use. In these cases, the health and satisfaction of residents may also be improved. Presumably, with a concomitant reduction in residents with mental health problems, nursing homes may be better able to provide mental health (and other) services to impaired residents.